Program Consultant Quality​/Member Rights Specialist Wisconsin Family Care

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Position Title:

Program Consultant Quality/Member Rights Specialist Wisconsin Family Care

Program Consultant Quality/Member Rights Specialist Wisconsin Family Care

Wisconsin

This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Program Consultant Quality/Member Rights Specialist will be responsible for member rights and performs quality reporting to DHS, including Critical Incident reporting. Program consultants typically support business strategies through an integrated portfolio of external client facing projects or initiatives.

Performs quality reporting to DHS, including Critical Incident reporting. Serves as a member advocate and works directly with members to assist with navigating care, appeals and grievances, maintaining income eligibility, and other member rights-related needs. Ensures the Member Rights Specialist/quality function remains fully independent from other health plan functions, consistent with contractual requirements. Works with members, income maintenance agencies, ADRCs, and other partners to gather information needed to maintain member eligibility.

Executes Member Rights Specialist and quality reporting activities within contractually-defined timelines and requirements to reduce risk of non-compliance and associated penalties. Manages the development, approval, implementation and compliance of on-going external client facing programs. Develops program budget. Ensures program meets its stated objectives. Provides subject matter expertise in response to day to day business issues. Researches applicable subject matter practices and remains aware of industry trends.

Manages relationships and partners with corporate and regional business areas. Coordinates training related to the external client facing program. Develops program success measures and performs periodic assessments of external client facing program success.

Requires a BA/BS in a related field and minimum of 3 years experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.

Graduate degree, professional designation related to field or project management experience preferred.

Non-Management Exempt Workshift:
Job Family: BSP >
Program/Project

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.